: Pityriasis lichenoides (PL) is an inflammatory papulosquamous condition that exists in a continuous spectrum that consists mainly of pityriasis lichenoides et varioliformis acuta and pityriasis lichenoides chronica (PLC). The condition has been reported to erupt in response to infections, radiocontrast media, medications and vaccines. Most case reports on vaccine-related eruption involve the acute PL, hence, this report aimed to present a case presenting with lesions of the chronic variant. : A 21-year-old female presented with multiple erythematous to hyperpigmented ill defined plaques, some ulceronecrotic, topped with fine scales and excoriations on the upper and lower extremities, periumbilical area and back of 4 months duration, following rabies vaccinations. : Histopathologic findings, including interface dermatitis, parakeratosis, spongiosis, and mixed inflammatory infiltrates, confirmed the diagnosis of PLC. The patient responded well to oral corticosteroids and heliotherapy. PL is rare and requires additional research. The potential role of vaccination as an etiologic agent represented a crucial area of this investigation. Additionally, heliotherapy should be considered as a viable therapeutic alternative when phototherapy is not feasible.. Further research is needed to elucidate the pathogenesis of PL and establish evidence-based treatment protocols.
Pityriasis lichenoides chronica ; Pityriasis lichenoides ; heliotherapy ; vaccine

Adult ; Humans ; Male ; Pityriasis Lichenoides ; diagnosis ; drug therapy ; immunology ; Prednisolone ; administration & dosage ; therapeutic use ; Psoriasis ; diagnosis ; drug therapy ; immunology ; Young Adult

BACKGROUND: Pityriasis lichenoides (PL)-like skin lesions rarely appear as a specific manifestation of mycosis fungoides (MF). OBJECTIVE: We investigated the clinicopathological features, immunophenotypes, and treatments of PL-like MF. METHODS: This study included 15 patients with PL-like lesions selected from a population of 316 patients diagnosed with MF at one institution. RESULTS: The patients were between 4 and 59 years of age. Four patients were older than 20 years of age. All of the patients had early-stage MF. In all patients, the atypical lymphocytic infiltrate had a perivascular distribution with epidermotropism. The CD4/CD8 ratio was <1 in 12 patients. Thirteen patients were treated with either narrowband ultraviolet B (NBUVB) or psoralen+ultraviolet A (PUVA), and all of them had complete responses. CONCLUSION: PL-like MF appears to have a favorable prognosis and occurrence of this variant in adults is uncommon. MF should be suspected in the case of a PL-like skin eruption. Therefore, biopsy is required to confirm the diagnosis of PL-like MF, and NBUVB is a clinically effective treatment.
Adult ; Biopsy ; Diagnosis ; Humans ; Mycosis Fungoides* ; Phototherapy* ; Pityriasis Lichenoides ; Pityriasis* ; Prognosis ; Skin

No abstract available.
Methotrexate* ; Pityriasis Lichenoides* ; Pityriasis* ; Prednisolone*

BACKGROUND: Pityriasis lichenoides, an inflammatory skin condition of unknown etiology affecting both children and adults encompasses a clinical spectrum between pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis lichenoides chronica (PLC). Although reported to follow a more self-limiting course in children compared with adults, there are a few studies comparing pityriasis lichenoides in both age groups in Korea. OBJECTIVE: The aim of this study was to evaluate the clinicopathological features, overall efficacy of treatments, and disease outcomes in children and adults diagnosed with pityriasis lichenoides. METHODS: This was a retrospective study of pityriasis lichenoides at our center between January 2003 and December 2013. Clinical manifestations and histopathological features of 54 patients with pityriasis lichenoides were analyzed. We also evaluated the clinical course in children and adults according to Gelmetti's classification. RESULTS: In this study, 36 patients were children (mean age 11.6 years, range 3approximately18 years) and 18 patients were adults (mean age 34.7 years, range 19approximately55 years). Lesions on the face were observed more commonly in children (n=18, 50%) compared with adults (n=1, 5.5%). Of the clinical features, vesiculation, crust and pigmentary changes were significantly more common in children than in adults. After treatment, 12 children (33.3%) and 10 adults (55.6%) went into complete remission. Histopathological features were not significantly different between children and adults. They just showed the difference between PLEVA and PLC. Dyskeratosis, epidermal necrosis, intraepidermal red blood cell (RBC) trapping, and RBC extravasati on in the dermis were more prominent in PLEVA than in PLC. By Gelmetti's classification, disease duration was longer in children with the peripheral type (38.5 months) than in children with the diffuse and central types. In adults, the diffuse type lasted longer (24.5 months) than the central and peripheral types. CONCLUSION: This study suggests that, compared with adults, pityriasis lichenoides in children is more likely to follow an unremitting course, with more facial/acral involvement and pigmentary changes and a poorer response to conventional treatment modalities. Applying the Gelmetti's classification, disease duration was longer in children with the peripheral type than other types. However, in adults, the duration was longer with the diffuse type.
Adult* ; Child* ; Classification ; Dermis ; Erythrocytes ; Humans ; Korea ; Necrosis ; Pityriasis Lichenoides* ; Pityriasis* ; Retrospective Studies ; Skin

BACKGROUND: Methotrexate (MTX) is a synthetic folic acid analogue with anti-proliferative and anti-inflammatory properties, and is prescribed for a variety of dermatological disorders. OBJECTIVE: The aim of this study was to investigate the therapeutic responses, adverse effects, and risk factors of MTX for dermatological use. METHODS: We retrospectively evaluated age, gender, underlying diseases, initial and cumulative doses of MTX, treatment duration, physician's global assessment (PGA) scores, and adverse effects in 200 dermatological patients treated with MTX. RESULTS: Various dermatoses responded to MTX in the following order of effectiveness: psoriasis vulgaris, pustular psoriasis, pityriasis lichenoides, atopic dermatitis, mycosis fungoides, and morphea. Adverse effects of MTX were observed in 64 of the 200 patients (32%) as follows: elevated liver function tests (LFTs) in 36 (18%), nausea or vomiting in 22 (11%), complete blood count abnormalities in 5 (2.5%), and a burning sensation over the lesion in 4 (2%). All patients who showed abnormal LFTs were normalized after reducing or stopping MTX, and the mean time to normalization was 5.76 weeks. Liver fibrosis was not found. Risk factors for MTX-related adverse effects were old age (p=0.028), skin disease (p=0.018), high initial dose of MTX (p=0.023), and high cumulative dose of MTX (p=0.044). CONCLUSION: Among various dermatoses, psoriasis showed an excellent response to MTX with relatively acceptable safety in Koreans, but regular monitoring of MTX-related adverse effects is important. The risk factors for MTX-related adverse effects were old age, psoriasis, high initial dose, and high cumulative dose.
Blood Cell Count ; Burns ; Dermatitis, Atopic ; Folic Acid ; Humans ; Liver Cirrhosis ; Liver Function Tests ; Methotrexate* ; Mycosis Fungoides ; Nausea ; Pityriasis Lichenoides ; Psoriasis ; Retrospective Studies ; Risk Factors ; Scleroderma, Localized ; Sensation ; Skin Diseases ; Vomiting

Febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta (PLEVA), or febrile ulcerative Mucha-Haberman disease (FUMHD) is very rare, but potentially lethal variants of PLEVA. This subtype is characterized by rapidly progressive ulceronecrotic lesions and systemic manifestations, such as high fever, gastrointestinal, neurological, cardiologic and pulmonary involvement, and rheumatologic manifestations. Several treatments with variable response have been challenged, such as systemic steroid, antibiotics, methotrexate, dapsone, cyclosporine and ultraviolet therapy. But there is no standard therapy for FUMHD to date. We report a 59-year-old woman with FUMHD, who recurred after discontinuation of systemic steroid, but successfully treated with oral cyclosporine.
Anti-Bacterial Agents ; Cyclosporine ; Dapsone ; Female ; Fever ; Humans ; Methotrexate ; Middle Aged ; Pityriasis ; Pityriasis Lichenoides ; Ulcer ; Ultraviolet Therapy

Febrile ulceronecrotic Mucha-Habermann's disease (FUMHD) is an unusual severe form of pityriasis lichenoides et varioliformis acuta (PLEVA) characterized by abrupt onset of widespread ulceronecrotic cutaneous eruption associated with high fever and systemic symptoms. In most cases, a mild typical form of PLEVA was usually present prior to the acute fulminating course. We report a case of FUMHD in a 6-month-old infant, who presented widespread hemorrhagic papules and coalescent thickly crusted ulcerations, high fever, liver dysfunction, and diarrhea with histopathologic findings suggestive of PLEVA.
Diarrhea ; Fever ; Humans ; Infant* ; Liver Diseases ; Pityriasis Lichenoides ; Ulcer

Febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta (PLEVA) is a very rare cutaneous disorder clinically characterized by the acute onset of erythematous papules, vesicles and large coalescent ulceronecrotic lesions on the whole body accompanied by high fever and severe constitutional symptoms. In general, ulceronecrotic lesion is preceded by a typical rash of PLEVA. Histopathologically, it shows widespread epidermal necrosis and fibrinoid necrosis of blood vessel walls in addition to the superficial and deep perivascular lymphocytic infiltrations. Several regimens including systemic corticosteroid, antibiotics, methotrexate or ultraviolet therapy have been challenged in this disorder . We report a typical case of febrile ulceronecrotic PLEVA in a 10-year-old child who showed a dramatic response to methotrexate.
Anti-Bacterial Agents ; Blood Vessels ; Child* ; Exanthema ; Fever ; Humans ; Methotrexate ; Necrosis ; Pityriasis Lichenoides* ; Pityriasis* ; Ultraviolet Therapy

BACKGROUND: Pityriasis rosea is an acute inflammatory dermatosis with an unproven etiology. The typical clinical feature consists of an initial, single herald patch followed by development of smaller, disseminated, papulosquamous, ovoid macules. However, an unusual papular type of pityriasis rosea is relatively common in children and it shows similar clinical characteristics to pityriasis lichenoides. OBJECTIVES: Our purpose was to observe the clinical and histologic features of pityriasis rosea and pityriasis lichenoides, and differentiate two diseases in children. METHODS: Sixteen children with pityriasis rosea and nineteen children with pityriasis lichenoides were investigated clinically and histologically. RESULTS: 1. Clinically, pityriasis rosea may be differentiated from pityriasis lichenoides by the existence of herald patch, short duration, the uniformity of size and shape, and residual pigmentation. 2. Focal parakeratosis, intraepidermal vesicle and papillary derma edema are more common in pityriasis rosea. In contrast, deep dermal infiltration, dyskeratosis, epidermal necrosis and confluent parakeratosis are more common in pityriasis lichenoides. 3. Comparing to the plaque type, a papular type of pityriasis rosea shows more involvement in the extremities with longer duration. Histologically, parakeratosis and papillary dermal edema are less and spongiosis is more commonly observed in papular type. CONCLUSIONS: Pityriasis rosea in children often shows papules especially on the extremities, similar to that of pityriasis lichenoides. However, from the results in this study, we believe that two diseases can be differentiated if both clinical and histologic findings are carefully studied.
Child* ; Edema ; Extremities ; Humans ; Necrosis ; Parakeratosis ; Pigmentation ; Pityriasis Lichenoides* ; Pityriasis Rosea* ; Pityriasis* ; Skin Diseases